The following manuscript was submitted to the May 2018 Mental Health theme issue.
“Locker room culture” is a common trope that has been used to describe the medical community of the recent past. Current practitioners will say that culture is, unfortunately, still prevalent. I have friends who were asked about when they were planning to have children during residency interviews. I have seen female attendings getting ignored in favor of male medical students. I have heard lewd comments being made about nurses. I have been present when male medical students insinuated that an attending was in a bad mood. And in many of these incidents I, like many others, have remained silent and allowed this culture to propagate.
Women doctors have had to manage harassment by patients, by their peers, and from supervisors. From being referred to as “girls” and assumed to be “the nurse” to having to endure sexualized jokes, inappropriate touching, and frank requests for sexual favors.
Then there are the colleagues who don’t think it’s a “big deal” or say she is being “dramatic” or “emotional” and minimize the day in and day out diminishment and dismissal that women doctors face.
The wisdom has been to take it in stride or otherwise it will build resentment. To have humility, grace, and be impeccable at your job. To always wear a white coat and stethoscope. This is all very much similar to the “be twice as good” advice that people of color have received for years. Female physicians have taken this advice to heart. Recent studies have shown that female physicians are more patient-centered, have better bedside manner, practice more evidence based medicine, and have lower mortality and readmission rates when compared to their male counterparts.
There are more women in medicine than ever before, but this is not reflected in our leadership. In 2014, 48% of all students graduating from U.S. medical schools were women. In contrast, only 16% of medical school deans were women. In Canada, 55% of graduates were women, yet there was only one dean and two chairs of medicine who were women.
Twenty-two percent of obstetrics and gynecology department chairs are women despite the fact that 83% of obstetrics and gynecology residents are women. It remains harder for women to get promoted, and women physicians are chronically underpaid, with the annual salaries of female academic physicians being 8.0% ($19,879) lower than those of male physicians.
Patients have also been subjugated to this male chauvinism. There is a great investigative reporting series done by The Atlanta Journal-Constitution which showed that in two-thirds of federally reported sexual misconduct cases, doctors either didn’t lose their licenses or are reinstated after being repeatedly sanctioned.
Even though the American Medical Association has declared sexual misconduct a breach of medical ethics, it has refused to expel every sexual offender from its membership rolls and has never looked into the prevalence of sexual abuse in clinical settings. It has, however, fought to keep confidential the National Practitioner Data Bank, the federal repository detailing disciplinary actions against doctors for sexual misconduct, making everyone wonder how many Larry Nassars are current members of the AMA.
We are currently undergoing a moment in America where “open secrets” are no longer tolerated and fairness is being valued over the status quo. This change has touched most professions, but this conversation is not being had in the halls of medicine. Clearly, this is not because structural sexism is absent in medicine.
The strict hierarchy of medicine ensures that how doctors engage with each other is determined not only by knowledge and experience but also by where a doctor fits into the pecking order. With younger physicians having to readily ingratiate themselves for the sake of work, this has left little room for conversations about bias and discrimination, a fact compounded by lack of diversity in leadership. However, this current cultural moment is too important for medical institutions to pass up. We should not be waiting for our Harvey Weinstein or Roy Moore to start addressing this issue.
As a man, I have some inherent privileges. One of them is the ability to stand up and speak my mind knowing that I am being listened to. And I am saying this “locker room culture” needs to stop. Another male privilege is the ability to create space. So I am writing to urge my male colleagues to be quiet, step aside, and listen to the female voices. This is crucial.